Position Statement on Disruptive Behavior

The Florida Board of Medicine offers its expertise and guidance to health care facilities and other health care professionals in dealing with the issue of disruptive behavior. The American Medical Association (AMA) defines disruptive behavior as physical or verbal personal conduct that has a negative effect or potentially has a negative effect on patient care.1 Statistics show that an estimated 3 to 5 percent of all physicians fall into this category of behavior.2 Disruptive behavior may be a one-time event or a pattern of behavior that can contribute to negative outcomes in patient care. The term disruptive behavior is useful in determining conduct which fall under this pattern of behavior so as not to confuse disruptive behavior with the firm expression of medical opinions during the course of patient care.

Disruptive behavior can arise from a variety of reasons such as underlying impairment issues, personal and professional stressors and specific personality traits. Between 2005 and 2015, the Professionals Resource Network, Inc. (PRN) reported that 178 practitioners were referred for evaluation because of behavioral concerns. Of those 178 referred, 128 (71%) were diagnosed with serious and potentially impairing conditions, and 46 were not diagnosed with an impairing condition, but were in need of assistance in the form of mentoring, anger management courses, stress management coaching or other approaches. 3

Behavioral policies are required as a component of accreditation through The Joint Commission, and TJC issued a leadership standard beginning in 2009, LD.03.01.01, mandating that health care organizations address disruptive and inappropriate behaviors in two of its elements of performance:

-EP4: the hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors

-EP5: leaders create and implement a process for managing disruptive and inappropriate behaviors4

The Board recommends health care facilities/organizations take the following steps to address disruptive and inappropriate behavior:

1. The Board suggests that healthcare facilities establish a code of conduct that define acceptable behavior and institute behavioral policies and procedures that can be reviewed and signed by physicians during their initial credentialing and during subsequent re-credentialing cycles. 2. On the first reported occurrence of disruptive behavior, the health care facility’s Chief of Staff, Chief of Service or Chief Medical Officer could speak with the physician engaging in such behavior. 3. On the next reported occurrence of disruptive behavior, the physician could be asked to appear before the health care facility’s wellness committee or other appropriate committee. 4. If the disruptive behavior continues, the physician could be asked to voluntarily submit to an evaluation by PRN to exclude impairment. 5. Finally, the health care facility could mandate the referral of the physician to PRN for evaluation.

The Board acknowledges that there is no easy solution to this issue. The Florida Board of Medicine encourages hospital/organization leadership to develop specific guidelines and processes for managing issues of disruptive and inappropriate behaviors among physicians and health care professionals since they present potential threats to the health and safety of patients, the health care team and the environment of care.